Report an Incident

Please use this form to report an incident of misconduct you received or witnessed.

Incident Date*
Date Format: MM slash DD slash YYYY
Class Name*
Instructor Name*
Your Name*
During today's class, I was a...*
- Teaching Artist
- Student
- Moderator
Your Email Address
Please provide a contact email address if you would like to receive a follow-up email regarding the recourse of this incident.
Date of Incident*
Date Format: MM slash DD slash YYYY
Location of Incident*
Name of person grievance is being filed against:*
Person's contact email, if available
Please describe the event in as much detail as possible:*
Please cite any policies, procedures, or guidelines you feel have been violated:
Were there any witnesses?*
If yes, please provide names and contact information for the witnesses:
Is this the first time you've raised this concern about this person?*
Specifically referencing this concern.
Proposed solution of grievance:*
Please upload any files affiliated with this incident, if any.
Drop files here or
Consent*
I understand and agree
I understand by checking this box that my incident report will be sent to Joy of Motion's Executive Leadership & the Joy of Motion's Faculty Committee who will then create a recourse plan for this incident. Depending on the severity of the incident, this information may also be shared with Joy of Motion's Board of Directors.